Doctors Slow to Embrace Electronic Medical Records

WEDNESDAY, June 18 -- Electronic medical record systems are being touted as the wave of the future in health care and communication, but only 17 percent of U.S. doctors have embraced the technology, a new survey finds.

"When you use a good definition of what a record system is, very few physicians appear to have one," said lead study author Catherine M. DesRoches, at Massachusetts General Hospital's Institute for Health Policy, in Boston.

The definition of a fully functional electronic medical record system includes a patient's complete medical records, medication lists, problems, and clinical notes from past visits. The doctor can also order prescriptions, laboratory tests and radiology tests electronically, DesRoches said.

In addition, the doctor can review lab results and view X-rays, MRIs or other scans on the computer, DesRoches noted. There are also warnings about inappropriate prescriptions or abnormal lab results. And the systems remind the doctor when lab or screening tests are needed.

For the survey, DesRoches and her colleagues surveyed 2,758 doctors nationwide about their use of electronic medical record systems. The researchers found that 4 percent reported having a fully functional system. An additional 13 percent said they had a basic system.

The survey also found that primary care doctors and doctors with large practices or those in hospitals or medical centers were more likely to have electronic medical record systems. In addition, doctors in the western region of the United States were more likely to have such systems.

The findings, published online Wednesday, were expected to be published in the July 3 edition of the New England Journal of Medicine.

Doctors cited a number of barriers for not adopting an electronic medical record system, including concern about cost and return on investment, DesRoches said.

"They also worry about their system becoming obsolete," she said. "They also worry that the system is going to go down, and they will have a waiting room full of patients, and they can't get to anyone's record."

But, she added, doctors who have these systems are very satisfied with them. "It makes care more effective and efficient," she said.

DesRoches thinks that eventually, most doctors will adopt an electronic system. In fact, the survey found that 40 percent of those physicians who did not have an operational system said they had purchased one but hadn't started to use it, or they planned to buy one, she said.

Both Medicare and private insurance companies are pushing doctors to adopt electronic medical record systems as a way of monitoring quality of care, which will be a basis for reimbursement levels, DesRoches noted.

One electronic medical records expert doesn't think this survey truly reflects which physicians are using electronic systems or takes into account the ultimate goal of computerized medical care.

"What we are talking about is moving physicians into the computer age," said C. Peter Waegemann, chief executive officer of the Boston-based Medical Records Institute, which promotes the use of electronic medical records. "We are changing the way physicians practice medicine, from an intuitive art to a computer-guided, computer-based care system."

Waegemann said that while only about 20 percent of doctors have electronic record systems, the number varies by specialty and region of the country.

"About 50 percent of family practitioners have electronic health record systems. Among pediatricians, 40 to 50 percent have systems," Waegemann said. "In states such as Massachusetts, New York and California, you have maybe 40 to 50 percent implementation. When you get to Mississippi and Idaho, you have maybe 4 percent."

Electronic medical records are coming rapidly, Waegemann predicted. Forces pushing their adoption include patient demand, younger doctors who were trained with such systems and pressures from the insurance industry.

Electronic records also make it easy for patients to send their medical records directly to doctors and specialists, Waegemann said, adding, "If physicians don't have such systems, patients will go elsewhere."